Patients are being put at risk by the way hospital services are currently organised and delivered in the northeast region, the Health Service Executive admitted yesterday.
The admission came at the publication of an independent review of acute hospital services in the region which found "serious current patient and staff safety issues", particularly in the provision of A&E, surgery and intensive care services.
Prof Brendan Drumm, chief executive of the HSE, said things would have to change but they would not change overnight.
The report set out a new framework for the development of services in the region, with one new hospital providing major services supported by and networked to existing local hospitals.
Prof Drumm said it would be "a blueprint for the development of services nationally", pointing out that hospital services in other regions also carried significant risks and required addressing.
The report said a new regional hospital should be built in the northeast from which A&E services for the entire area should be provided. This hospital will also provide emergency surgery, paediatrics and possibly maternity services for the whole area.
It is hoped it will be ready by 2015. A steering group is being set up to look at where it should be located. The report said none of the existing five hospitals in the region should close. These hospitals include Cavan General Hospital; Monaghan General Hospital; Our Lady of Lourdes Hospital, Drogheda; Louth County Hospital, Dundalk; and Our Lady's Hospital, Navan.
When the new hospital is built these local hospitals will provide minor injury units rather than A&E units staffed by specialist nurses. They will also provide a range of diagnostic services and outpatient clinics. Some may also do day surgery.
By 2015 some 120 less acute hospital beds will be needed in the area as more services will be community based, it said.
The review was carried out by UK based Teamwork Management Services, which has recommended that emergency surgery be immediately removed from Navan Hospital and moved to Drogheda. It said the emergency general surgical service in Navan "is presently held together by only two consultants".
Furthermore, it says that any general surgeon in the region can undertake occasional major planned operations, rather than referring patients to the appropriate sub-specialty team.
Many surgeons at Cavan General Hospital and Drogheda had undertaken operations on children in 2004. Some were doing less than 10 paediatric cases a year, it said.
The five hospitals also have critical care or intensive care facilities but there are no full time consultant intensivists in the region. This was "unsafe, unsustainable and in need of prompt action".
The report said there was an insufficient number of A&E consultants in the northeast to provide a safe and sustainable service. There are four A&E consultants overseeing 96,000 new A&E attendances each year in the region.
"These consultant staff are spread too thinly across four hospital sites and cannot provide sufficient clinical supervision to ensure the quality of service provision."
The A&E unit at Cavan General Hospital "has serious problems", it said, and is seriously deficient in consultant supervision.
At Navan and Dundalk it said patients attending A&E were seen by non-consultant hospital doctors supplied by a recruitment agency. "We are unaware of any monitoring of clinical performance and outcomes."
The report said that it seemed the imperative was to keep the services open and that "scant attention has been, and is being paid to patient safety, clinical quality and performance of the sub-contracted services".
"The present system whereby five local hospitals in the northeast deliver acute care to small populations, has exposed patients to increased risks. This has to change," the report concluded.